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General NPI Number Information
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NPI Number | 1598222754
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Entity Type | Individual
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Provider Name | LUZ MARIA GORDON ROMAN
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Gender | Female
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Dates
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Enumeration Date | 02/25/2019
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Last Update Date | 02/28/2019
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Provider Practice Location Address
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Address Line | CARR 181 KM 9.1 BO DOS BOCAS
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976
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Country | US
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Telephone | 787-283-1920
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Fax |
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Provider Business Mailing Address
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Address Line | AVE. DIEGO VELAZQUEZ PA1 EL CONQUISTADOR
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976
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Country | US
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Telephone | 939-226-3120
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 3379
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License Number State | PR
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